Sinus venosus atrial septal defect treatment device

ABSTRACT

The sinus venosus atrial septal defect (“ASD”) treatment device includes has a generally tubular or funnel shaped configuration. A first end of the device can have a diameter that is less than a diameter of a second end of the device. The device can be inserted in the right upper right pulmonary vein PV. The second end of the device is configured to expand in a skirt-like configuration once the device is positioned in the right upper right pulmonary vein PV. In this manner, the device closes the upper sinus venosus hole and diverts anomalous pulmonary venous drainage into the left atrium.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. patent application Ser. No.15/891,653, filed on Feb. 8, 2018, which claims the benefit of U.S.Provisional Patent Application No. 62/458,527 filed Feb. 13, 2017, thecontents of which are herein incorporated by reference in theirentirety.

BACKGROUND 1. Field

The present disclosure relates to a percutaneous interventional device,and particularly to a sinus venosus atrial septal defect treatmentdevice and method.

2. Description of the Related Art

Typically, in a normal functioning heart, the left atrium receives theoxygenated blood from each of the four pulmonary veins. After receivingit, the oxygenated blood flows into the left ventricle, where theoxygenated blood is subsequently pumped to the brain, organs, andtissues of the body. The right atrium, on the other hand, receives thedeoxygenated blood from the superior vena cava and inferior vena cavaand other cardiac veins and then pumps deoxygenated blood into the rightventricle, which subsequently pumps the deoxygenated blood into thepulmonary system to replenish its oxygen supply. Normally, the leftatrium and the right atrium are separated by a septum known as theinteratrial septum that prevents the oxygenated blood in the left atriumfrom mixing with the deoxygenated blood in the right atrium.

However, if the interatrial septum fails to properly develop an atrialseptal defect (ASD) can result. An ASD is a hole in the interatrialseptum that allows the oxygenated blood to mix with the deoxygenatedblood. If the ASD is left untreated, it can lead to lower than normaloxygen in the atrial blood that is pumped from the left atrium to thebrain, organs, and tissues of the body, which can eventually lead to thedevelopment of a cardiac arrhythmia, decompression sickness,Eisemnenger's syndrome, paradoxical embolus, and even migraines.

There are four types of ASDs, an ostium secundum ASD, an ostium primumASD, a sinus venosus ASD, and a coronary sinus ASD, the ostium secundumASD being the most prevalent. While ostium secundum and ostium primumASDs account for approximately 70% and 20%, respectively, of the totalnumber of ASDs, sinus venosus ASDs account for approximately 10% of thetotal number of ASDs. The most common type of sinus venosus ASD occursat the junction of right atrium and the superior vena cava, which is thelocation where the pulmonary veins enter the heart. In other words, oneof the four pulmonary veins, such as the right upper pulmonary vein,drains into the right atrium instead of the left atrium. While ostiumsecundum ASD can be treated percutaneously, as well as surgically, todate, there is no percutaneous interventional procedure for treatingsinus venosus ASDs.

Thus an atrial septal defect treatment device and method solving theaforementioned problems is desired.

SUMMARY OF THE INVENTION

The sinus venosus atrial septal defect (“ASD”) treatment device includesa flexible proximal portion at a first end, a flexible distal portion atan opposing second end, and a flexible central portion between theproximal portion and the distal portion. The device has a hollow lumenand is open at opposing ends thereof The opening at the first end isexpandable from a first diameter when the device is being deployedthrough the body of the left atrium, to a second, larger diameter whenthe device is positioned within the right upper pulmonary vein andexpanded with a balloon catheter. The proximal portion includes aplurality of receiving plates with respective keyholes configured toreceive a corresponding key from a balloon portion of a ballooncatheter. The distal portion includes a self-expandable edge portion orskirt. The skirt can include a septal augmenter rim configured forsecuring the device to the left atrium side of the interatrial septum.

These and other features of the disclosed technology will become readilyapparent upon further review of the following specification anddrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is an environmental side view of an atrial septal defecttreatment device in collapsed form.

FIG. 1B is another environmental side view of the atrial septal defecttreatment device in expanded form.

FIG. 1C illustrates the configuration of the atrial septal defect deviceexpanded within a pulmonary vein of a heart.

FIG. 2 illustrates the atrial septal defect device positioned on aballoon catheter positioned on a guide wire.

FIG. 3 illustrates a locking system for securing the atrial septaldefect treatment device to a balloon of a balloon catheter.

FIG. 4 illustrates the atrial septal defect treatment device secured tothe balloon of the balloon catheter via the locking system.

FIG. 5 illustrates the balloon catheter positioned on the guide wire,the balloon catheter and the corresponding guide wire being positionedwithin a second sheath, the second sheath being positioned with a firstsheath used to position the atrial septal defect treatment device withinthe pulmonary vein.

FIG. 6 illustrates the second sheath utilized to position the atrialseptal defect device in the pulmonary vein of the heart having a sinusvenosus ASD.

FIG. 7A illustrates the atrial septal defect treatment device extendingfrom the pulmonary vein into the left atrium via the interatrial septumof the heart having a sinus venosus ASD.

FIG. 7B is an exploded view of the view illustrated in FIG. 7A.

Similar reference characters denote corresponding features consistentlythroughout the attached drawings.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIGS. 1A-7B, an atrial septal defect treatment device 100,configured for the percutaneous closure of a sinus venosus atrial septaldefect for diversion of anomalous pulmonary drainage into the leftatrium, is generally illustrated. The device 100 has a generally tubularor funnel shaped configuration. A first end 122 of the device 100 canhave a diameter that is less than a diameter of a second end 124 of thedevice 100. The device 100 can be inserted in the right upper rightpulmonary vein PV. The second end 124 of the device 100 is configured toexpand in a skirt-like configuration once the device 100 is positionedin the right upper right pulmonary vein PV. In this manner, the device100 closes the upper sinus venosus hole and diverts anomalous pulmonaryvenous drainage into the left atrium, as illustrated in FIGS. 7A and 7B.

The device 100 includes a flexible proximal portion 110 at the first end122, a flexible distal portion 130 at the opposing second end 124, and aflexible central portion 120 between the proximal portion 110 and thedistal portion 130. The device 100 has a hollow lumen and is open atopposing ends 122, 124 thereof.

The proximal portion 110 can have any suitable shape, such as agenerally cylindrical shape. The proximal portion 110 includes aself-expanding mesh 112 that can be formed from any suitableinterlocking medical grade material, such as Nitinol. An opening 119 atthe first end 122 is expandable from a first diameter D1 (FIG. 1A), suchas when the device 100 is being deployed through the body of the leftatrium, to a second, larger diameter D1′ (FIGS. 1B and 1C), such as whenthe device 100 is positioned within the right upper pulmonary vein andexpanded using a balloon catheter. The second diameter can range, forexample, from about 10 mm to about 15 mm. The proximal portion 110 canhave any suitable length L1, such as a length ranging from about 15 mmto about 20 mm. In an embodiment, the proximal portion 110 can include aplurality of attachment receiving structures or receiving plates 114 forreceiving a corresponding attachment device or key. For example, each ofthe receiving plates 114 can include an aperture or keyhole 116. Thekeyhole 116 can include a circular first portion 117 a and rectangularsecond portion 117 b extending from the first portion 117 a. The keyhole116 is configured to receive a corresponding key from a balloon portionof a balloon catheter, as will be further described in detail below. Theplurality of plates 114 can include three plates 114, such as metalplates, vertically positioned around the proximal portion 110 of thedevice 100.

The central portion 120 of the device 100 can have any suitable lengthL2, such as a length ranging from approximately 10 mm to approximately15 mm. The central portion 120 can include a plurality of flexible,e.g., self-expandable, metal rods 126. The metal rods can be spaced fromeach other. Each metal rod 126 can be formed from any suitable medicalgrade material, such as Nitinol, and may be covered by any type ofsuitable medical grade material, such as polytetrafluoroethylene. Thecentral portion 120 also includes an aperture 128 that remains uncoveredfor side branch stenting in case of the need for extra support or forbifurcating drainage. The edge or area immediately surrounding theaperture 128 may be radio-opaque. The aperture 128 can have any suitablediameter, such as a diameter of approximately 5 mm.

The distal portion 130 can have any suitable length L3, such as 10 mm.The distal portion 130 includes a self-expandable edge portion or skirt132 formed from a plurality of interlocking metal rods 134, such asNitinol rods, that can be arranged in a grid formation or in a meshformation. Each of the metal rods 134 may be covered, such as partiallycovered, with polytetrafluoroethylene. For example, an end of each metalrod 134 attached to the central portion 120 may be covered withpolytetrafluoroethylene and an opposing end of each metal rod 134 may beleft bare (i.e. uncovered).

The skirt 132 of the opposing distal portion 130 can have any suitablediameter, such as a first diameter D3 when collapsed and positioned onthe balloon 202 of the balloon catheter 200 and a second larger diameterD3′ (FIG. 1C) when expanded to occlude the sinus venosus atrial septaldefect (e.g. opening) from the left atrium LA side of the interatrialseptum IS. When the sinus venosus atrial septal defect (e.g. opening) isoccluded in this manner, oxygenated blood can flow directly into theleft atrium LA of the heart H without escaping into the right atrium RA.The skirt 132 can include an expandable septal augmenter rim 136. Theseptal augmenter rim 136 is configured for securing the device 100 tothe left atrium LA side of the interatrial septum IS once the septalaugmenter rim 136 is inserted into the left atrium LA side of theinteratrial septum IS. Once expanded, the septal augmenter rim 136 cananchor the opposing distal portion 130 of the device 100 within the leftatrium LA side of the interatrial septum IS.

The device may be positioned in the right upper right pulmonary vein PVusing a balloon catheter 202 (FIG. 3 and FIG. 4). A balloon portion 202of the balloon catheter 200 includes attachment structures or lockingplates with one or more keys 118, e.g., radio-opaque mushroom shapedkeys (FIG. 4) configured for insertion in respective keyholes 116 of thedevice 100. Each keyhole 116 is suitable for receiving a correspondingkey 118, such as a mushroom shaped key with circular head and stemextending therefrom. The balloon catheter 205 is inserted into thedevice 100 outside of the body, via the distal portion 130 of the device100, to secure the device 100 thereto. Each key 118 fits into acorresponding keyhole 116 of each plate 114. Clockwise rotation of thecatheter moves the stem of the mushroom key to fit in the keyhole secondportion 117 b so as to secure the device 100 to the balloon 202 of theballoon catheter 200 to facilitate delivering the device 100 within thepulmonary vein PV of the heart H. It should be understood that thekey/keyhole attachment described herein is provided as a non-limitingexample. The attachment structures can include any structure whichallows the catheter to engage the device 100.

By way of operation, initially a trans-femoral vein approach is used byadvancing a first sheath 215, e.g., a large caliberdeflectable/steerable sheath having a size ranging from 9Fr to 12Fr,into the femoral artery and toward the interatrial septum IS (FIG. 6).This is followed by making a trans-septal opening 600 with atrans-septal needle (not shown), just below the sinus venosus atrialseptal defect (ASD) in the interatrial septum IS separating the rightatrium RA from the left atrium LA (FIG. 7).

The trans-septal opening 600 allows for vascular access, as well asaccess into the target pulmonary vein PV. In this manner, pulmonary veinPV may be targeted via the inferior vena cava IVC, as illustrated byarrow A in FIG. 6. The steerable sheath 215 is configured for supportingand providing access into the pulmonary vein PV from the left atrium LA,via the interatrial septum IS, as illustrated in FIG. 6. Such steerablesheaths are well known in the art and can include the Agilis™ NXTSteerable Introducer from St. Jude, the FlexCath Advance SteerableSheath from Medtronic, and the Vado® Steerable Sheath from Abbott.

A guide wire 205, e.g., an elongated stiff “J” tip guide wire, is thenadvanced through the steerable sheath 215 to the coronary arteries. Thesteerable sheath 215 is used to properly position the guide wire 205within the target pulmonary vein PV. Once the guide wire 205 is properlypositioned, a second sheath 210 including a tip 212 with a radio-opaquemarker is inserted within the steerable sheath 215, over the guide wire205, and into the target pulmonary vein PV via the left atrium LA.

Once the second sheath 210 is properly positioned within the targetpulmonary vein PV, the balloon catheter 200, secured to the device 100via locking system 300, is then inserted through the second sheath 210and over the guide wire 205 until the balloon catheter 200 reaches thetarget pulmonary vein PV. The balloon 202 is then inflated, such as byfilling the balloon 202 with fluid, such as saline, as is known in theart. By inflating the balloon 202, the proximal portion 110 of thedevice 100 expands within the target pulmonary vein PV so as to fitsecurely within the target pulmonary vein PV. Once the balloon isinflated, the catheter 200 is disengaged (e.g. unlocked) from the device100, such as by twisting the catheter 200 to remove the keys 118 fromthe keyholes 116.

After the balloon 202 is disengaged from the proximal portion 110 of thedevice 100, the second sheath 210 and the balloon catheter 200 areretracted along the guide wire 205 back through the atrial septaldefect. As the balloon catheter 200 and the second sheath 210 areretracted, the self-expandable skirt 132 of distal portion 130 of thedevice 100 expands on the left atrium LA side of the interatrial septumIS, as illustrated in FIGS. 7A and 7B. After expanding within the leftatrium LA side of the interatrial septum IS, the septal augmenter rim136 may anchor the distal portion 136 within the left atrium LA side ofthe interatrial septum IS to prevent oxygenated blood from flowing intothe right atrium RA. Once the proximal portion 110 of the device 100 isproperly positioned within the target pulmonary vein PV and the opposingdistal portion 130 of the device 100 is properly positioned on the leftatrium LA side of the interatrial septum IS, the oxygenated blood mayflow from the lungs, through the target pulmonary vein PV and into theleft atrium LA of the heart H.

It is to be understood that the disclosed technology is not limited tothe embodiments described above, but encompasses any and all embodimentswithin the scope of the following claims

1. A sinus venosus atrial septal defect treatment device, comprising: atubular body having opposed first and second open ends, the body beingdefined by: a proximal portion having an expandable peripheral wall, theexpandable peripheral wall of the proximal portion including a ballooncatheter locking system on an exterior surface thereof; a distal portionhaving an expandable peripheral wall, the expandable peripheral wall ofthe distal portion including an expandable septal augmenter rim at anedge portion thereof; and a central portion between the proximal portionand the distal portion, the central portion including an expandableperipheral wall.